Centre for Community Medicine All India Institute of Medical Sciences

Centre for Community MedicineAll India Institute of Medical Sciences Behaviour Change: Patient to Patience

Centre for Community MedicineAll India Institute of Medical Sciences Dr. Chandrakant.S. Pandav Professor and Head Centre for Community Medicine AIIMS, New Delhi Dr. Rakesh Kumar MBBS, MD (AIIMS) Senior Programme officer ICCIDD, New Delhi Dr. Kapil Yadav MBBS, MD (AIIMS) Senior Programme officer ICCIDD, New Delhi Dr. Ravi P. Upadhyay Resident Doctor Centre for Community Medicine AIIMS, New Delhi Dr. Rahul Srivastava Resident Doctor Centre for Community Medicine AIIMS, New Delhi

Outline of Presentation • Behaviour Change • Behaviour and public health • Determinants of behaviour • Stages of behaviour change • Behaviour change process • Enabling factors • Channels of communication • Myths and facts regarding behaviour change • Conclusions

Behaviour Change …1 List the important changes in the pictures ???

Behaviour Change…2 Today its me, because of u...Tomorrow its u, because of me... Fully burnt Cigarette ASH Smokers Lung Quit smoking... Tar the roads... NOT your LUNGS!

Behaviour Change…3 • Increased interest of behaviour change in different fields with the hope that understanding it will improve the services offered • Health • Education • Criminology • Energy • International development • Behavioural changetheories have gained recognition in health for their possible effectiveness in explaining health-related behaviours and providing insight into methods that would encourage individuals to develop and maintain healthy lifestyles

Behaviour Change…4 • Different terms used for behaviour change • Strategic Behavioral Communication (SBC) • Information, Education, Communication (IEC) • Communication for Social Change (CSC) • Behaviour change communication (BCC)

Behaviour Change …5 • Many theories exist for Behaviour change, the most prevalent are • Learning theories • Social Cognitive Theory • Theories of Reasoned Action and Planned Behaviour • Trans-theoretical Model • Health Action Process Approach

Behaviour Public Health Fortunately, human beings have, in theory, control over their conduct Smoking • Non communicable diseases such as (NCDs) • Diabetes • Obesity • Hypertension, • Cancers, etc. Alcohol Dietary Behaviours Diseases Behaviour Change Physical Activity Sexual Activity HIV, STD, Hepatitis Healthy life Substance abuse Mental Disorders Rash Driving Road Traffic Accidents Health-compromising behaviors can be eliminated by self-regulatory efforts, and by adopting health-enhancing behaviors

Determinants of health related behaviour

How to change behaviour ???Five stages of behaviour change Stage 1 Precontemplation Stage 5 Maintenance Stage 4 Action Stage 2 Contemplation Stage 3 Preparation

Stages of Behaviour change… Diabetes Stage 1 Precontemplation Stage 2 Contemplation Stage 3 Preparation Stage 4 Action Stage 5 Maintenance I don’t have disease ….. I am no more Happy… I am worried… I am having Diabetes I am ready to change I am doing… I will continue to do…. • I want to LIVE... I will save myself • Prevention is better then cure • Learn regarding healthy practices • Filter facts from Myths • Doctor calling • Dietary changes • Physical activity • Regular medicines • Positive re-enforcement, Negative re-enforcement and awarding • Opinion leader Why should I change ????

Diffusion of Ideas Model People are more likely to adopt a new behavior when someone they respect or admire endorses the behavior: • Opinion leaders influence an initial group • New social norm is established • Rest of community follows (Social conformation)

Behavior Change Process Stages of change continuum Channels Mass media Community networks and traditional media Interpersonal/group communication Enabling factors • Unaware • Aware • Concerned • Knowledgeable • Motivated to change • Trial behaviour change • Sustained behaviour change • Effective communication • Enabling environment • User friendly services and accessible commodities

Myths and facts about behaviour change Myths Facts People go into denial of the bad things that might happen to them Crisis is a powerful impetus for change Change is motivated by fear • To achieve sustainable results, it takes time. • Regular reinforcements are needed We can't change because our brains become "hardwired" early in life • Majority of patients don't sustain changes in the unhealthy lifestyles that worsen their disease • Change for better is always difficult to make Behaviour change methods don’t yield adequate results We can continue learning complex new things throughout our lives Change in behaviour is not sustained • Behaviour addressed should be the “felt need” of the people targeted • Community involvement is important for success of any change process

Behavior change is a continuous process • It involves strong community participation • Refutes myths and corrects misunderstanding • Social norms and public policies influence behavior change. A strategic shift must be also be attempted simultaneously. • BCC often complements and supports other prevention strategies and approaches

Stepped approach to change A journey of a thousand miles begins with a single step

Thanking You

Centre for Community Medicine All India Institute of Medical Sciences